Breast Cancer Genome-Wide Association Studies: There Is Strength in Numbers
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Oncogene (2012) 31, 2121–2128 & 2012 Macmillan Publishers Limited All rights reserved 0950-9232/12 www.nature.com/onc REVIEW Breast cancer genome-wide association studies: there is strength in numbers D Fanale1,3, V Amodeo1,3, LR Corsini1,3, S Rizzo1, V Bazan1,2 and A Russo1,2 1Department of Surgical and Oncological Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy and 2Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA Breast cancer (BC) is a heterogeneous disease that Introduction exhibits familial aggregation. Family linkage studies have identified high-penetrance genes, BRCA1, BRCA2, Breast cancer (BC) is the most common cancer and the PTEN and TP53, that are responsible for inherited BC second leading cause of cancer death among women syndromes. Moreover, a combination of family-based and (Parkin et al., 2005). population-based approaches indicated that genes involved The family history is the main risk factor for BC, in DNA repair, such as CHEK2, ATM, BRIP and indicating that the genetic factors are very important in the PALB2, are associated with moderate risk. Therefore, all development of disease (Antoniou and Easton, 2006). of these known genes account for only 25% of the familial In the 1990s, linkage studies in multiple case families have aggregation cases. Recently, genome wide association identified two major susceptibility genes in BC BRCA1 and studies (GWAS) in BC revealed single nucleotide poly- BRCA2 (Miki et al., 1994; Wooster et al., 1995). morphisms (SNPs) in five novel genes associated to Germline mutations in BRCA1 and BRCA2 genes susceptibility: TNRC9, FGFR2, MAP3K1, H19 and occur rarely in the general population but confer high lymphocyte-specific protein 1 (LSP1). The most strongly risks of breast and ovarian cancer and a lower risk for associated SNP was in intron 2 of the FGFR2 gene that is other cancers (Antoniou et al., 2003; Thompson and amplified and overexpressed in 5–10% of BC. rs3803662 Easton, 2004). of TNRC9 gene has been shown to be the SNP with the TP53 and PTEN mutations are also present in the strongest association with BC, in particular, this poly- population at low frequency and lead to very high BC morphism seems to be correlated with bone metastases risk associated with rare cancer syndrome, however, and estrogen receptor positivity. Relevant data indicate population-based studies have estimated that alterations that SNP rs889312 in MAP3K1 is correlated with BC in these genes account only the 15% of the familial risk susceptibility only in BRCA2 mutation carriers, but is not of BC (Sidransky et al., 1992; FitzGerald et al., 1998; associated with an increased risk in BRCA1 carriers. Peto et al., 1999; Dite et al., 2003). Finally, different SNPs in LSP1 and H19 and in minor Further, genetic linkage analyses failed to identify genes probably were associated with BC risk. New additional high-penetrance susceptibility genes and the susceptibility allelic variants associated with BC risk were identification of rare variants of genes involved in DNA recently discovered including potential causative genes repair, such as CHEK2, ATM, BRIP and PALB2 in involved in regulation of cell cycle, apoptosis, metabolism families lacking BRCA mutations (Meijers-Heijboer and mitochondrial functions. In conclusion, the identifica- et al., 2002; Thompson et al., 2005; Rahman et al., tion of disease susceptibility loci may lead to a better 2007; Hollestelle et al., 2010), associated with a understanding of the biological mechanism for BC to moderate risk of disease, can explain only a small improve prevention, early detection and treatment. portion of familial risk. Oncogene (2012) 31, 2121–2128; doi:10.1038/onc.2011.408; Therefore, all of these known genes account for only published online 26 September 2011 25% of the familial aggregation cases (Thompson and Easton, 2004), suggesting that most of the familial risk Keywords: FGFR2; GWAS; H19; LSP1; MAP3K1; of BC can plausibly involve a combination of multiple TNRC9 low-penetrance susceptibility alleles, each conferring a small effect on BC risk (Antoniou and Easton, 2006; Table 1). According to this model defined ‘polygenic’, proposed to explain the genetic susceptibility to BC, a large number of low-risk variants occurs with high frequency Correspondence: Professor A Russo, Department of Surgical and in populations, therefore, it may have a multiplicative Oncological Sciences, Section of Medical Oncology, Universita` di effect in determining the overall risk of disease (Pharoah Palermo, via del Vespro 129, 90127 Palermo, Italy. et al., 2002; Figure 1). A significant part of polygenic E-mail: [email protected] 3These authors contributed equally to this work contribute to low-penetrance susceptibility may rise by Received 10 July 2011; revised 9 August 2011; accepted 9 August 2011; non-conservative missense mutations in evolutionarily published online 26 September 2011 conserved domains. GWAS in breast cancer D Fanale et al 2122 Table 1 Genetic loci implicated in breast cancer susceptibility population the identification of a susceptibility allele with a frequency of 5% requires over 800 cases. In the High penetrance, Low penetrance, Low penetrance, low frequency low frequency high frequency same population, the identification of a susceptibility allele with a frequency of 1% requires over 3700 BRCA1 CHEK2 FGFR2 unselected cases, whereas about 700 would be enough BRCA2 ATM TNRC9 if three affected families are selected. Therefore, the p53 PALB2 LSP1 PTEN BRIP1 MAP3K1 power of association studies can be significantly SLC4A7 increased using selected cases with a family history of COX11 cancer because less cases are required to demonstrate the association with disease (Houlston and Peto, 2004). The potential of the association studies of cases with a family history to identify low-penetrance alleles confer- ring a relative risk of 2 has been demonstrated by the mutation CHEK2 1100delC in patients with BC. This variant carried by 1% of the population confers an increased risk of 1.7-fold. The frequency was not significantly increased in unselected cases (1.4%), but it was strongly increased in familial cases without BRCA1 and BRCA2 mutations (5.1%; Meijers-Heijboer et al., 2002). In the past years several novel risk alleles for BC were identified by four recent GWA studies: Breast Cancer Association Consortium, Cancer Genetic Markers of Susceptibility, DeCode Islanda, Memorial Sloan–Ket- tering Cancer Center (Easton et al., 2007; Hunter et al., 2007; Gold et al., 2008; Stacey et al., 2008). In each of them the association study was shared into Figure 1 Allelic variants at low frequency tend to be associated with higher relative risk of BC (for example, BRCA1, BRCA2), three phases: the first phase identifies the common SNPs high-frequency allelic variants are associated with lower RR in cases and controls, the second phase evaluates how (for example, FGFR2, LSP1, and so on) configuring an inverse many of the above SNPs are common to a greater correlation. number of cases and controls and, finally, the third phase aims to identify new alleles of susceptibility of BC. Easton et al., in their study, identified five indepen- Genome-wide association studies (GWAS) dent loci associated with increased susceptibility to BC (Po10À7). This multistage study involved in the first In recent years the research of low-penetrance allelic stage 390 BC cases with a strong family history and variants was conducted mainly through GWAS. These 364 controls, and 3990 cases and 3916 controls in the studies use a large number of common genetic single second stage. nucleotide polymorphisms (SNPs) to identify associa- To define the risk associated with the 30 most tions with disease that rely upon patterns of linkage significant SNPs, a third stage of the study was disequilibrium (LD) in the human genome (Hirshfield conducted involving 21 860 cases and 22 578 controls et al., 2010). The power of GWAS is to evaluate the from 22 additional studies in the Breast Cancer association of genetic variants at different loci on Association Consortium. different chromosomes (LD) in large series of cases These combined analyses allowed to observe that the versus controls, analyzing a panel of hundred thousand SNPs showing a stronger statistical evidence of associa- SNPs simultaneously, to identify new alleles of suscept- tion with an increased familial risk were: rs2981582 lies ibility to BC (Orr and Chanock, 2008). In the human in intron 2 of FGFR2, rs12443621 and rs8051542 within genome has been estimated that there are seven million TNRC9, rs889312 lies in a region that contain MAP3K1 of common SNPs that have a minor allele frequency gene, rs3817198 lies in intron 10 of lymphocyte-specific (m.a.f.), 45% and because recombination occurs in protein 1 (LSP1) and rs2107425 within the H19 gene. different hot-spots, the nascent polymorphisms are often Unlike other BC susceptibility genes previously strongly correlated. identified that are involved in DNA repair and sex These studies therefore provide a powerful tool to hormone synthesis, in this work three of the five loci identify novel markers for susceptibility and prognosis reported contain genes involved in regulation of cell of disease (Peto, 2002; Houlston and Peto, 2004; Easton growth and cell signaling (Easton et al., 2007). and Eeles, 2008). In the GWA studies the accumulation Starting from this study of Easton et al., in attempt of a large number of data is crucial. Houlston and Peto, to identify further loci associated with BC risk, (2004) have estimated the number of cases required to Ahmed et al. have genotyped in a third stage further identify low-penetrance alleles conferring a relative risk 814 SNPs, involving 3878 cases and 3928 controls from of two both in an unselected population and in families three studies of the Cancer Genetic Markers of with first-degree relatives affected. In an unselected Susceptibility.